What determines quality in palliative sedation? A scoping review identifying elements contributing to palliative sedation quality.

Abstract

Palliative sedation involves using sedatives to reduce consciousness until death. Though common in end-of-life care, it remains complex and controversial, with unclear quality parameters and limited guidance for improvement. A comprehensive overview of elements that reflect quality in palliative sedation is currently missing. To identify quality reflecting elements for palliative sedation reported in peer-reviewed, indexed and gray literature. Scoping review using Levac et al.'s methodological framework, including systematic searching, screening and narrative synthesis. Academic databases with indexed sources (MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO) and databases also containing gray literature (MEDNAR, Web of Science) were searched between February and December 2023 for sources with primary data published after 2009, without restrictions on population or study design. Among the 60 sources analyzed, 157 elements reflecting palliative sedation quality were identified and thematized into 22 themes and four overarching domains: (1) process elements of decision-making such as indication, proximity to death, timing, patient involvement, proactiveness, patient support, family involvement, artificial nutrition and hydration; (2) process elements of performance, such as level of sedation, medication use, monitoring, duration, care continuation, family support; (3) outcome elements covering patient comfort, family well-being, family satisfaction, professionals' well-being and satisfaction; (4) process elements of collaboration and documentation. This scoping review found a broad range of elements reflecting palliative sedation quality - beyond clinical performance, sedation outcomes or patient level elements alone. These insights can inform the development of a core set of indicators to support quality monitoring in palliative sedation.